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Admin
547 Posts |
 Posted - 02/14/2003 : 11:17:17
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In an article posted today on insurancejournal.com an adjuster was convicted of federal fraud charges. Some of the charges against the Adjuster involved kickbacks. Kickbacks come in many forms. Your involvement in the claim should always be above reproach. The way you handle salvage, the free tickets from the insured, letting contractor's buy your meal or a drink at the local bar and the gift from an engineer are just some of the things that can lead to problems.
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katadj
USA
315 Posts |
Posted - 02/14/2003 : 22:30:28
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This type of exposure is what creates the poor image of the "catadjuster", even if the individual was a staff member, we are envisioned by the carrier as "one of them".
We are the most efficient, hardest working, and most motivated of every adjuster in North America, (USA & CA).
We have proven our worth, In Hugo, Andrew, Northridge, Valdez, Canada in '98 and more others than can be mentioned. WE are the core. WE are the "goto" people, WE are the absolute "best of the best", the "A" team if you will.
Yet, despite our individual efforts to prove our worth, we get "branded" by those that choose to protect their own posteriors.
Is it Fair?, Is it reasonable? Of course not, but Ladies and Gentlemen, it is fact.
We have a hard road to hoe, when some choose the lower road, and we who choose the higher road are associated therewith.
"Unto thine own self be true" |
Edited by - katadj on 02/14/2003 22:32:45 |
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KileAnderson
USA
875 Posts |
Posted - 02/14/2003 : 22:39:19
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| Not to be too picky but the saying is "Hard ROW to hoe". You don't hoe in the road, unless you're talking about a different kind of "ho". |
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katadj
USA
315 Posts |
Posted - 02/14/2003 : 22:49:03
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| KIle, You are correct, as a farmer it is a "row to hoe". I was thinking that our ROAD is difficult. Apologies are proffeed. |
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Cheryl Joyce
USA
45 Posts |
Posted - 02/15/2003 : 00:33:14
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| There is always a rotten apple in the pile, but not all are affected by the one. Because one apple has a worm does not mean they all do. |
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Admin
547 Posts |
Posted - 02/15/2003 : 11:34:45
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Here's another story. This was posted on the Bulletin Board and has been moved here at Jimbo's request.
"FORT WORTH _ A former high school counselor who admitted killing a friend with an arsenic-laced cocktail in 1976 was indicted this week on federal wire fraud charges in what prosecutors called one of the most brazen insurance scams in North Texas.
The indictment accuses Charles Howard of lying about his criminal past to obtain an insurance agent's license from the State Department of Insurance in 1995. In 1998, Howard again denied having been convicted of a crime when he applied to Allstate Insurance in Irving to land a job as a claims adjuster, the indictment said."
Cick here to read to the full story.
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CCarr
Canada
1200 Posts |
Posted - 02/15/2003 : 12:55:51
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It is very unfortunate that we read about this type of 'cookie jar' activity, all too often. I'm sure I read about at least two of these events per month up here. As Dave pointed out, we are all painted with the same brush in the public's perception of this type of thing. Back in my carrier days, this crept into the carrier environment far too often and at varying levels of 'players'. It truly is a heart renching experience to bring the career of an otherwise decent person to an end, when you finally have the evidence of the hand in the jar. Denial seems to be the first reaction, not a denial of the act, but a denial of the responsibility and affect of that action they took; and a denial that it is defined as theft or fraud. I have seen good people and their families torn to hell, as a result of their actions down that dark trail. There have been all kinds of studies and 'papers' written on 'employee theft / fraud' and the reasons why; but that is not the issue here.
Because of this type of thing not being an uncommon event in the corporate culture of things, many large carriers have had corporate 'Internal Investigation Units' for 30 years or more now. This type of fraud or theft is certainly not limited to the claims department. It is proportionally found in Admin Purchasing, Underwriting, and Vendor Management departments; and reaches (as it does in claims) from the lowest levels to the higher ranks of upper management. These scams rise to the surface in many styles, and seem like a big waste of creativity.
Corporate 'governance policies' have resulted that are very strict in an attempt to minimize the opportunity for these things, but at the same time they can make it more difficult for an adjuster to interact with necessary vendors.
Perhaps the perpetrators of these illegal acts, are like minded to a research poll that I read late last year, that was conducted in Canada. The question asked was, "is it okay to defraud an insurance company of money in a claim?" Over 60% of the respondents said "yes", and the underlying reason that evolved was the 'Robin Hood theory' of taking from the rich to give to the poor.
As to all this 'hoe' and 'ho', I guess it depends on the context and regional slant to the expression or act. However, a farmer does hoe his row, but I think Dave has pegged it correctly; the path of an adjuster is much harder and wider to follow for many reasons, and hence I agree that an adjuster must hoe the road. |
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ChuckDeaton
USA
373 Posts |
Posted - 02/16/2003 : 15:58:44
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| Actually the saying, at least among those of us who have hoed a row, is "a long row to hoe." It comes from hoeing the weeds out of cotton. Standing at the end of a cotton row, at daylight, knowing that quittin' time won't be until after dark, spawned the saying. Hoeing weeds isn't hard it is endless. If you would like to see it I have an original hand made hoe. |
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TomToll
USA
87 Posts |
Posted - 02/16/2003 : 18:56:17
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Chuck is absolutely right. I have hoed many a row, as has Janice. We both were raised on a farm where time did not exist when you worked. I have sat on a steel tractor seat from sunrise to sunset+. It did not hurt us in any way, but gave us a deeper/positive feeling about life in general. I wish more young people had the opportuntiy to do that type of work, I think their attitudes would change dramatically. Janice and I both still carry that farm work tradition. Work is not finished until it is finished, and finshed the right way. My parents, as did Janice's, impressed upon us to do the job the right way the first time, and all the time. Even at age 14 I figured out how to make extra money. I was known in three counties for my ability to lay out the straightest bean row and was hired every year to lay out the first up and back rows. They paid me $6.00 to do this and it only took about 15 minutes, plus driving time. I was paid for my gasoline to drive to each farm. I had 42 farms every year to do. We had imaginations and ingenuity back then. You youngsters probably are laughing at $6.00. I could go to the show, buy popcorn and coke for .35 cents and gas was .19 cents per gallon, so that six bucks was a lot of money back in the 50's. Most farm laborers made $6.00 per day. My Uncle Ezra told me time and time again that attitude was the sparkle of life and the I should always apply the three P's. Perception, Perspicacity, and Perserverance. If you don't know what the three P's are, look them up and then strive to live by them. It has made mine and my wife's life full of joy and adventure. Does this make me an old fart, yep, and I love it
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Tom Toll |
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ChuckDeaton
USA
373 Posts |
Posted - 02/16/2003 : 20:18:26
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At ther'ud be a long row ta ho, wat,ju thank, Bubby.
That would be Tom Ed explaining to Earl (Bubby)why he was reluctant to give Junior the "whuppin'" he so sorely needed.
Anybody that would like to learn to speak Arkansaw can email me and I will see if I can find a scource for a text book. This dialect is also spoken in North Louisiana, East Texas and parts of Oklahoma.
Just to give Dave Hood a little credibility he did spend some time, in his youth, near Jasper and Mt. Judea along the Buffalo River. |
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JimF
USA
1014 Posts |
Posted - 02/17/2003 : 08:37:32
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The final product of our training must be neither a psychologist nor a brick mason, but a man. And to make men, we must have ideals, broad, pure and inspiring ends of living - not sordid money-getting, not apples of gold. The worker must work for the glory of his handiwork, not simply for pay; the thinker must think for truth, not for fame.
W.E.B. Dubois
The Souls of Black Folks
A Collection of Dubois Essays. |
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william s cook
53 Posts |
Posted - 02/17/2003 : 17:20:52
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Posted with permission from the source
1/4 of Americans Say Its Acceptable To Defraud Insurance Cos
One-Fourth of Americans Say It's Acceptable To Defraud Insurance Companies,
Accenture Survey Finds
Feb. 12, 2003--Nearly one in four U.S. adults say that overstating the value
of claims to insurance companies is acceptable, and more than one in 10 say
they approve of submitting insurance claims for items that were not lost or
damaged or for treatments that were not provided, according to a survey
released today by Accenture (NYSE:ACN).
The survey, based on a random sample of more than 1,000 U.S. adults,
examined consumer attitudes toward insurance fraud. Two-thirds of
respondents (66 percent) said that people are more likely to commit
insurance fraud during an economic downturn than when the economy is strong.
About half the respondents (49 percent) said that people commit insurance
fraud because they can get away with it.
Thirty percent of respondents linked insurance fraud to the offenders' needs
for money, while nearly one-fourth (24 percent) said they believe that the
people who commit insurance fraud do so because they believe they pay too
much for insurance. Twenty percent said they believe that the offenders
commit fraud to compensate for the claims deductibles they have to pay.
"The Insurance Services Office, Inc. estimates that the cost of fraud in the
U.S. property and casualty industry is approximately $24 billion, which
represents 10 percent of total claims payments," said Michael A. Lucarini, a
partner in Accenture's Insurance practice. "Fraud is a growing concern for
insurers, whose aging technology and inefficient processes often prevent
them from detecting fraudulent claims, which in turn hurts their long-term
profitability. In addition, increased consumer exaggeration to improve the
claims payout is becoming more prevalent in the current weakened economy."
Slightly more than one in 10 of survey respondents (11 percent) said they
knew of someone who inflated the value of their insurance claim. These
respondents said they believed that these claims were mainly for auto and
property/homeowners insurance (47 percent and 39 percent, respectively, of
respondents who knew of inflated insurance claims).
Forty percent of respondents said they were unlikely to report someone who
has committed fraud. However, 83 percent of respondents said they believe
that insurance companies are capable of identifying or preventing
fraud-related property and casualty insurance claims.
"The burden is clearly on insurance companies to ensure they have the proper
tools, technologies and skills to combat fraud," Lucarini said. "Those
committing fraud are becoming more sophisticated and advanced in their
methods, while many insurance companies still lack the necessary processes
and systems to detect and stop fraud. However, leading insurers are
implementing Web-based technology that can help re-evaluate claims for fraud
during the claims lifecycle and alert the appropriate people when thresholds
are exceeded."
Survey Methodology
Accenture commissioned Taylor Nelson Sofres (TNS) Intersearch to conduct a
national survey about insurance fraud. The study comprised telephone
interviews with 1,030 U.S. adults (at least 18 years of age) in November
2002. Of these respondents, 298 said they had filed a property/casualty
insurance claim for personal, property, auto or homeowners' insurance or for
worker's compensation.
TNS Intersearch is a U.S. member of Taylor Nelson Sofres, the fourth-largest
marketing information company in the world, with offices in more than 50
countries.
About Accenture
Accenture is the world's leading management consulting and technology
services company. Committed to delivering innovation, Accenture collaborates
with its clients to help them realize their visions and create tangible
value. With deep industry expertise, broad global resources and proven
experience in consulting and outsourcing, Accenture can mobilize the right
people, skills, alliances and technologies. With more than 75,000 people in
47 countries, the company generated net revenues of $11.6 billion for the
fiscal year ended August 31, 2002. Its home page is www.accenture.com.
CONTACT: Accenture
Marykate Dolan Reese, 917/452-8738
Marykate.reese@accenture.com
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KileAnderson
USA
875 Posts |
Posted - 02/19/2003 : 18:03:02
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Here is another story along the same lines from the AP:
Wednesday, February 19, 2003
NEW YORK — A $100 million federal program to reimburse New Yorkers for air conditioners, filters, vacuums and other air-purifying tools after the World Trade Center collapse is rife with fraud and misuse, government officials say.
As many as 90 percent of the more than 219,000 applications for reimbursement were filed by people not suffering from the effects of contaminated air, according to estimates from federal officials running the program.
They say fraud has taken several forms, from individuals who manipulated the program to score a free air conditioner to con artists who posed as federal employees to recruit applicants and generate sales of air-purifying items.
About $45.8 million has been paid out so far and, while many applications are legitimate, officials concede that millions have been paid to people scamming the system. The government's concern is so great that it is sending a dozen teams of inspectors daily to applicants' homes to verify claims.
Despite the problems, the federal government's recourse is limited: Officials can turn cases over to prosecutors, though none have brought charges; or they can attempt to reclaim money.
The grants were set up by the Federal Emergency Management Agency to reimburse residents in all five boroughs for the purchase of air quality items, up to about $1,500 per applicant.
Unlike other aid programs created specifically to address the Sept. 11 attack, the reimbursements came from an existing program. The program is traditionally used to help individuals and families with costs not covered by other assistance programs, but FEMA officials say they have never encountered this level of misuse in prior disasters.
The size and extent of the program have proven to be among its problems.
Because so many trade center grants were limited to lower Manhattan residents, this program was open to all New York City residents, said Brad Gair, FEMA's trade center federal recovery officer.
"We were trying to do the right thing. Unfortunately, people took advantage of that so now we have people way out in Queens or upper Manhattan where there was no potential for air quality impacts," Gair said.
As word spread about the ways to cheat the system, Gair says, a program that was originally budgeted at $15 million — and initially had trouble attracting applicants — turned into a clogged $100 million program.
Now, teams of FEMA investigators are visiting the homes of those who applied for air conditioners, in an attempt to authenticate that the new appliance is replacing one damaged by the polluted air after the towers' collapse.
About 20 visits are completed daily, during which they make notes that are passed along to officials who then decide if the claim is valid. Some applicants have not received money, others cashed checks months ago.
"We know we've come across people who are not telling the truth," says Jack Casale, a FEMA investigator, during a day of visits to homes in Queens, more than 10 miles east of the trade center.
Scientists and federal environmental officials are still studying the effect of trade center dust and the pattern of its movement after the collapse, but experts agree that the cloud hovered over lower Manhattan and spread mostly south toward Brooklyn.
Casale's first stop was the home of a man who had applied for an air conditioner reimbursement. During the interview, the man told Casale that his air conditioner worked fine until July 2002 — 10 months after the collapse released its plume of dust and ash.
"The air conditioner was bad — I don't know if it was for that reason," the man admitted.
Casale made a note on his report, but emphasized later that another department decides whether claims should be paid.
Investigators have discovered numerous cases where people purchased FEMA-covered items, submitted the receipts to get reimbursement checks and then returned the products to the store, pocketing the cash. Some receipts even appear to be forged, Gair said.
Home visits have turned up residents who applied for air conditioner reimbursements actually living in buildings with central air where the windows don't even open. Other times, they find that applicants who received checks for hundreds of dollars worth of reimbursed purchases cannot produce the items when investigators visit their homes. Meanwhile, home and electronics stores have reported to FEMA unusual numbers of people returning air conditioners, vacuums and air purifiers.
Local district attorneys say no applicants have been charged in relation to the FEMA reimbursement program — in part because it may be difficult to prove that someone taking advantage of the system is breaking any laws.
The city's Department of Consumer Affairs also is investigating, but is concentrating on the wider-scale scams run by people who posed as FEMA employees to generate applications and then sell air quality products at inflated prices. If proven, that would be an illegal trade practice.
FEMA would not name the vendors suspected of deceiving consumers. But anyone who submits receipts from those companies is not getting money "until we can sort this out," Gair said.
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Davey
USA
38 Posts |
Posted - 02/19/2003 : 18:30:06
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| New York! New York! It's a hell of a town. But given the nature of the type of fraud, it could happen anywhere, per Bill Cook's expose'. Southern California wasn't much different after the 94 EQ. |
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TomS
USA
32 Posts |
Posted - 02/21/2003 : 06:14:57
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| I read the article and believe this was the guy on a tell-all T.V. show a few years ago about the earthquake deal and how bad carriers treated insureds and paid I.A.'s. Can somebody check that out. |
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Are you giving Adjusters a bad name?
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